2. Please describe your agency's mission (no more than 3 sentences or 250 characters).
Tri-Valley Haven creates homes safe from abuse, contributes to a more peaceful society. One person, one family one community at a time. Together we build a world without violence.

3. For what type of Dublin Grant is your agency applying?

Capital Project

Public Service/Program/Project

4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation.

Yes

No

5. Please indicate below if this application is a request for one-time funding and/or "seed" funding.

One-time funding

Seed funding

One-time and Seed funding

Neither / not applicable

6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City/County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if you HAVE received Dublin Grants.
N/A

7. Please provide information to justify your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.).
Tri-Valley Haven is in its 35th year of services, having began operating a crisis line and shelter out of a Board member's home in 1977. Since then services have greatly expanded. They now include providing domestic violence, homeless and sexual assault services. Domestic violence services include 24-hour crisis line; Shiloh, a 30-bed confidential shelter; individual and group counseling; restraining order assistance; and community outreach and education. Our Rape Crisis Center opened in 1981 and offers sexual assault services to residents of the Tri-Valley area. These services include crisis response, advocacy, individual counseling, support groups, community outreach and education. Haven homeless services began in 2002 and currently include Sojourner House, a homeless shelter, and a food pantry. Sojourner House is the only shelter in the area that will accept single dads and teen boys. Life Skills groups offered at Sojourner House make program a huge success since they equip our clients with skills that they've never had before. The skills that a critical for returning or entering the life without homelessness. The Haven offers several other support services to its clients to provide a more comprehensive approach towards healing and self-sufficiency.

Tri-Valley Haven's major governing body is the Board of Directors. Each Board Member's term is two years. Our Management team consists of the Executive Director and six managers. Tri-Valley Haven has its own Finance and Compliance Department. All of our Direct Service staff such as Case Managers, Life Skills Instructors etc. is required to have a Bachelors Degree or equivalent life experience.

8. Provide a brief summary of the project for which your agency is seeking funding (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project.
Tri-Valley Haven's Homeless Services Program will provide assistance with issues related to Homelessness through the Shelter, job readiness/job seach Life Skills education and the Food Pantry.

9. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project.
300

10. Describe specific problem(s), need(s), issue(s), or service gap(s) to support the need for this project in Dublin. Include demographics, statistics, reports, etc.
According to the latest Census report there are 1795 (3.9% from the Total population) Dublin residents living in the poverty. Low or very low income families are more likely to be forced to pay more than they can afford in rent, thus making them more susceptible to housing problems such as eviction. The Tri-Valley Human Services Needs Assessment noted that chief among the service gaps for homeless or near homeless families is a lack of locally based homeless services. Sojourner House is the only shelter in the Tri-Valley area that accepts two parent families and single fathers, and most residents are from the Tri-Valley Area. It is important to them to remain in their own community where their kids go to school and their jobs are. In the Fiscal Year 10/11 340 Dublin residents received services through the Food Pantry and the Homeless Shelter. Just last week some 40+ Dublin residents received help through our Holiday Program that's helping low or very low income families to get the Christmas gifts for their loved ones that otherwise they wouldn't be able to afford.

11. Explain how this project will be implemented, administered, and operated.
Tri-Valley Haven's Homeless Services Program is an existing project. Clients get reffered to us via our website, shelter network, 211, Food Pantry, etc. Since we only have 16 beds at the Shelter, there is a waiting list and potential clients need to call and check the availability. Once the client is in she/he gets assigned to a Case Manager and a staff therapist, so together they can eveluate the needs and issues and set up the plan. We encourage clients to participate actively in the maintaining of the house, preparation of their meals, and cleaning up after themselves and their children. All shelter residents and community clients that are eligible (based on income) can utilize our Food Pantry for foodstuffs. Sojourner House is staffed nearly 24x7. Residents can stay up to 6 months.

12. Describe in detail the role of Dublin Grant funds in this project (e.g., what specifically will the grant funds be used for?).
The funds requested from Dublin will be used to pay part of the Case Manager's time and part of the Life Skills Instructor's time.

13. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)?
The most important outcome for us is when a family or an individual becomes self-sufficient and transitions successfully out of homelessness and into mainstream living. Another very important outcome is connecting clients with appropriate service/housing. Other outcomes can include: a client obtaining 30 days clean and sober for the first time in years, a resident gaining employment, a family getting medical insurance, a child feeling safe because he doesn't have to sleep in the car. We recognize small steps as personal accomplishments toward an overall goal. We truly believe that great success of the program can be maintained over time is almost never achieved in 30 days. The Tri-Valley Haven uses quantitative and qualitative evaluation methods. Quantitative methods include tools that track services provided and standirdized tools to assess each client's progress in the program. Progress is tracked though client files, direct service logs etc. We also utilize a database, R-Client that has larger tracking capacity. Qualitative methods include an open-ended feedback questionare, continuous eveluation by a case manager, clinical assessment by a licensed therapist.

14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, low-income, etc.
Our Homeless Shelter and Food Pantry clients are almost excusively extremely low through low income single parents with their children, intact families, single women, disabled individuals and seniors.Our ultimate goal is that upon completion of our program a family or an individual will successfully transition out of homelessness into mainstream living. At a very minimum our clients will be aware (in many cases will be waiting for an approval) of the programs and services that are available for them and will help them to reach their goals.Last year our Homeless Program (Shelter and the Pantry) served 15342 clients, of those 340 were from Dublin.

15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)?
We have multi-cultural staff members and volunteers who utilize their cultural backgrounds to enhance the services in the homeless program. Both staff and volunteers actively participate in the Diversity trainings. We presently have staff fluent in Spanish, Russian, Tagalog, French, Hindi, Urdu, Japanese and American Sign Language. Multi language fluency is always a consideration when hiring, and wage differentials are given to those fluent in Spanish. All of the Sojourner House (Homeless Shelter) and the Food Pantry intake forms, paperwork and flyers are in English and Spanish.

16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding?
We conduct regular Outreach efforts through many of the programs Tri-Valley Haven offers as well as through other community resources. These internal programs include our Food Pantry, 24-hour crisis line etc. Tri-Valley Haven's Holiday Warehouse Program for low-income families from Tri-Valley area brings new participants every year. Tri-Valley Haven participates in community health fairs and outreach events such as St. Patrick's Festival etc. We work closely with Lynnewood Methodist Church targeting encampments and harder to reach population groups.TVH staff maintains a good working relationship with CRIL, a local service provider for persons with disabilities and also is aware of key services such transportation for persons with disabilities and how to access them. Entrances to all Tr-Valley sites are clearly marked. Telephone screenings and in-person intake processes include questions about needed accomodations (such as a bottom bunk, private room or special dietary needs). Sojourner House was remodeled before it was opened in 2002 to onclude a ramp and a handicap accessible bathroom. Our Pantry has a portable ramp when appropriate, tho clients seldom come in beyond the counter.

17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration.
We have Operational Agreements with over 60 organizations including Police Departments from Livermore, Dublin and Pleasanton, District Attorney's Offices, schools, other domestic violence and homeless shelters, hospitals, and social service agencies. The Haven's Community linkages go beyond the Tri-Valley area via collaboratives with agencies throughout the Alameda County, including the Alameda County Family Violence Council, the CalWORKS Domestic Violence Advisory Board, and th Alameda County Everyone Home. The Haven, together with the other five agancies participates in the Alameda County Housing -Jobs Linkages Program to help clients obtain long-term housing, and achieve self-sufficiency. We have a very successful partnership with Lynnewood Methodist Church.

18. Describe marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific collaboration with other service organizations in the City of Dublin or Tri-Valley.
There are many ways we outreach to Dublin residents. Every year Tri-Valley Haven is using the St. Patrick's Festival as an opportunity to introduce our services and the work that we do to as many Dublin residents as we can. We conduct presentations to the Dublin Police Department on the Domestic Violence, Sexual Assault and Homelessness issues and the programs that Tri-Valley Haven offers. Another big outreach event is our annual Gingerbread project, that is actually taking place in Dublin High. We bake, decorate and sell cookies together with nearly 200 students and their parents. Our Community Education program reaches over 400 Dublin High school and Middle school students. We particurlarly work with the students in Dublin High, Valley Christian School, and also we run a "Be Strong" Group at the Wells Middle School. And last, but not the least, right this year 41 Dublin residents have been served throug the Holiday Wearhouse Program in Livermore. This Program is helping low and very low income families in the Tri-Valley area to prepare Thanksgiving dinner and shop for Christmas presents for their loved ones.

19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this project serves Dublin residents by meeting at least one of the City of Dublin’s Mission, Vision, Values, and Strategies.
Sojourner House is a sixteen bed facility that houses homeless couples with children, single parents with children and single women. Families stay in bedrooms and are encouraged to maintain a family-like atmosphier similar to what will be encountered upon exit from the shelter. Clients can stay for up to 6 months, during which time residents are provided support to stabilize and to develop the skills and knowledge to help break the cycle of homelessness. Sojourner House is staffed almost 24-hours a day, seven days a week. Case management is based on the empowerment model. Each participant works with their case manager to design a program that will best meet their needs that are unique to their family. Life skills is a critical program component that helps families to develop a budget, identify credit issues, assist in housing search, provide job coaching. We advocate for clients to help them access mainstream services and help motivate participants to be active agents of change in their lives, and the lives of their families. All residents are also linked to a staff therapist with whom they can meet on a weekly basis. Tri-Valley Haven’s CalWORKs Specialist provides services to domestic violence survivors at the homeless shelter. Sojourner House residents participate in Linkages, a subsidized transitional housing program with case management for clients who are working toward self-sufficiency. Clients in Linkages may remain in that program for up to 24 months. All Shelter residents utilize our Food Pantry for foodstuffs.The Food Pantry is located in Livermore and provides essential nourishment for low income residents of Tri-Valley Area The Pantry also provides emergency motel vouchers, gas and phone cards, and referrals to other social services

20. BUDGET NARRATIVE
Describe how this project is cost effective and how the budget is reasonable for the anticipated result.
Tri-Valley Haven's Homeless Services Program cross-utilizes other TVH services as much as possible to meet clients' needs and hold down costs. Residents are able to obtain food from the TVH Food Pantry, they are given clothing vouchers and referrals to Buenas Vidas Thrift Store, they receive help applying for government services such as Food Stamps etc. Health Services are provided through the Valley Care Mobile Health Unit. By utilizing in-house services whenever possible, expenses for outside services are minimized. Use of volunteers is also a major factor in helping hold the costs down.

21. If this application does not receive funding, what will be the effect on the project?
Without this funding Tri-Valley Haven would need to reduce the number of Life Skills classes that provide education on topics such as job interview, resume writing, budgeting etc. Those skills are very much needed for our homeless clients to be able to break the cycle of homelessness. Also the Case Management hours will need to be reduced. This reduction will have a detrimental effect on the amount and quality of support services provided to our clients.

22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year?

Yes

No

23. If you answered yes to the preceding question please explain. Enter "N/A" if not applicable.
N/A

25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N/A" if not applicable.
N/A

26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N/A" if not applicable.
N/A

Not known (please contact staff immediately if you have any questions regarding Davis-Bacon requirements)

28. PERFORMANCE MEASURES
Identify AT LEAST ONE of the City of Dublin’s Mission or Vision Statements: (you may choose more than one)

Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities.

Balance history with progress, to sustain an enlightened, economically balanced and diverse community.

Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings.

Promotes active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs.

29. Identify AT LEAST ONE of the City of Dublin’s Values: (you may choose more than one)

Building Community by promoting locations and events that brings people of all ages together; providing more venues for family-based activities and fostering heritage and cultural development

Ensuring a Safe Community by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety

Guiding Development to assure that development contributes positively to the City’s fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City

Governing that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication

Relating to Other Communities and Entities by encouraging collaboration and communication with other communities on issues of mutual concern

30. Identify AT LEAST ONE of the City of Dublin’s Strategies: (you may choose more than one)

Pursue economic development initiatives that attract new businesses while strengthening existing businesses

Continue to strengthen the identity and aesthetic appeal of the downtown

Create a community that supports environmental sustainability and provides an open space network that ensures environmental protection and provides public access where appropriate

Develop dynamic and unique community recreational and cultural opportunities in the region

Develop City-wide communication and outreach programs that provide connectivity with our residents and businesses across several media outlets

31. QUESTIONS 32 THROUGH 44 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING. Are you are interested in applying for CDBG funds?

Yes. If so, answer questions 32 through 44.

No. If no, check box here, and check the not applicable box at the end of each question.

Don't know. If you are unsure, please call the City at (925) 833-6610 and speak to a Staff person that can answer your questions.

32. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan(LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail.
The TVH Cultural Competence Plan has instituted a multi-pronged approach to improving services to clients with Limited English Proficiency (LEP). We have staff conversant in Spanish, Russian, French, Tagalog, Hindu, Urdu, Japanese, and American Sign Language. Bilingual and bicultural staff are in strong demand throughout Alameda County, and they are difficult to obtain and retain. We seek out bilingual/bicultural staff, and provide a wage differential for their linguistic abilities. We have a Video Relay Service for clients conversant in ASL. This two-way Internet-based video link gives hearing-impaired clients access to Sorenson’s ASL interpreters. If staff is not available to converse directly with an LEP client, we utilize “TeleInterpretors” phone-based interpreters. Our largest LEP client group is Spanish-speaking. Most flyers, client materials and other communications are created in both English and Spanish. We produce and distribute documents in other languages when available.

33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project:

Be culturally accessible, appropriate and inclusive

Encourage community engagement and involvement

Promote energy and resource efficiency

Encourage networking and information sharing across service providers

Encourage process streamlining

Consolidate service delivery

Not Applicable. I am not interested in qualifying for CDBG funding.

34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project:

A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that:

B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under-insured residents with emphasis on activities that:

* Support the maintenance and expansion of services and programs aimed at wellness and preventative care services.

C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate.

D) Support and expand programs and opportunities that keep seniors engaged and involved in their community.

E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations.

F) Not Applicable. I am not interested in qualifying for CDBG funding.

35. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project:

Increase homeownership

Promote decent affordable housing

Strengthen communities

Ensure equal opportunity in housing

Promote participation of grass-roots, faith-based, and other community-based organizations

Not Applicable. I am not interested in qualifying for CDBG funding.

36. Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project:

Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency.

Improving the quality of life for our Nation's communities

Encouraging accessible design features.

Participation of minority-serving institutions in HUD programs.

End chronic homelessness within ten years.

Removal of barriers to affordable housing.

Not Applicable. I am not interested in qualifying for CDBG funding.

37. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project:

Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households.

Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI).

Assist low and moderate income first-time homebuyers.

Reduce housing discrimination.

Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services.

Maintain and expand activities designed to prevent those currently housed from becoming homeless.

Build on inter-jurisdictional cooperation to achieve housing and homeless needs.

Increase the availability of service-enriched housing for persons with special needs.

Not Applicable. I am not interested in qualifying for CDBG funding.

38. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?"):

Creating a Suitable Living Environment

Providing Decent Affordable Housing

Creating Economic Opportunities

Not Applicable. I am not interested in qualifying for CDBG funding.

39. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?"):

Availability/Accessibility

Affordability

Sustainability

Not Applicable. I am not interested in qualifying for CDBG funding.

40. CDBG ONLY - Select ONE Specific Indicator that relates to your project:

Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service.

Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service.

Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate-income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area.

Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated.

Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated.

Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS.

Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS.

Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless.

Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless.

Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs.

Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted.

Homeless shelters: This indicator shows the number of homeless persons given overnight shelter.

Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing.

Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness.

Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee-sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job.

Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications)

Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance.

Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee.

Not Applicable. I am not interested in qualifying for CDBG funding.

41. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE):

Persons

Households

Not Applicable. I am not interested in qualifying for CDBG funding.

42. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project:
300

43. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients your agency anticipates serving in each category. "If none, please enter "0".

Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits)

Extremely Low Income (<30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov/housing/incomelimits)

Disabled

Female Headed Households

Senior

Youth

Homeless

Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A)

TOTAL

44. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "If none, please enter "0"

White

White + HISPANIC

Black/African American

Black/African American + HISPANIC

Asian

Asian + HISPANIC

American Indian/Alaskan Native

American Indian/Alaskan Native + HISPANIC

Native Hawaiian/Other Pacific Islander

Native Hawaiian/Other Pacific Islander + HISPANIC

American Indian/ Alaskan Native and White

American Indian/ Alaskan Native and White + HISPANIC

Asian and White

Asian and White + HISPANIC

Black/African American and White

Black/African American and White + HISPANIC

American Indian/Alaskan Native and Black/African American

American Indian/Alaskan Native and Black/African American + HISPANIC

Multi Racial + HISPANIC OR other Multi Racial

Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A)

TOTAL

45. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY

#1 - This program/project has the highest priority for funding within the organization, agency, district or entity.

#2 - This program/project has the 2nd highest priority for funding within the organization, agency, district or entity.

#3 - This program/project has the 3rd highest priority for funding within the organization, agency, district or entity.

#4 - This program/project has the 4th highest priority for funding within the organization, agency, district or entity.

#5 - This program/project has the 5th highest priority for funding within the organization, agency, district or entity.

#6 - This program/project has the 6th highest priority for funding within the organization, agency, district or entity.

If you have more than 6 applications per organization, agency, district or entity, check here.

Budget

Funding Sources/Revenues

Budget Amount

Amount Committed

Alameda County

$ 122,527.00

$ 0.00

Local/Dublin/Pleasanton/Livermore

$ 30,000.00

$ 0.00

Federal Emergency Shelter Grant

$ 25,000.00

$ 25,000.00

HCD Linkages

$ 41,943.00

$ 0.00

Foundations

$ 82,500.00

$ 0.00

Donations

$ 21,493.00

$ 0.00

Total

$ 323,463.00

$ 25,000.00

Funding Uses/Expenses

Budget Amount

Amount Committed

Case Manager, 16% of sal. and benefits

$ 7,083.00

$ 0.00

Life Skills Instructor, 5% of sal. and benefits

$ 2,917.00

$ 0.00

Other Program Personnel

$ 272,942.00

$ 20,680.00

Operating Expenses

$ 40,521.00

$ 4,320.00

Total

$ 323,463.00

$ 25,000.00

Budget Narrative

Revenue: The only amount that is fully committed is $25,000 from FESG. FESG Contract is ending 09/30/2012. Other revenue is our best estimate based on the previous years of operation.Expenses: Personnel Costs Shown include salaries and benefits. Operating Expenses include Supplies, Printing/Copying, Postage, Telephone, Utilities, Audit Services, Mileage and portion of Liability and Auto Insurance.

Documents

Instructions for Documents Requested

Below you will find a list of documents REQUIRED or requested to complete your application submittal process. Eight (8) documents are REQUIRED FOR ALL grant applications and are indicated by a check mark in the "required" box. The eight REQUIRED documents include: 1) Program Expense Budget for ALL Grants; 2) Financial Information Form for ALL Grants; 3) List of Board of Directors (or governing body) with contact information; 4) Current Annual Budget for the Entire Agency; 5) Copy of most recently submitted IRS 990 form or Tax Return (include complete form); 6) Board of Director's (or governing body's) designation of authorized official; 7) Board of Director's (or governing body's) authorization to request funding; and 8) Proof of insurance carried, including bonding, liability and/or workers' compensation. You should not submit your application until you have attached the REQUIRED documents.

A template is provided for two of the REQUIRED documents. One for the Program Expense Budget and one for the Financial Information Form. You must use these two provided templates. To download the required templates, click on the link "download template" which is located immediately below the name of the form, save the file to your computer, input your project information, save the file with a file name that make sense (ex: AgencyNameBudget.xls) and select "upload." After you have successfully uploaded your file and REFRESHED your browser, you will see your file listed in the "Uploaded Documents" column in the table below.

The "List of the Board of Directors" and "Current Annual Budget for the Entire Agency" do not require use of a City template. You may upload this information in any format (Word, Excel, pdf, jpg, etc).

Additional documents, as identified below, are REQUIRED only if you are applying for CDBG funds or a capital project. These documents do not require you to use a City provided template. You may upload this information in any format.

In addition, there are documents at the end of the list that are provided as a tool for your to use.

The Leveraging Report only applies to CDBG applicants.

The Contact Agreement for Community Support Grants and Housing In-Lieu Grants can be downloaded, completed, and uploaded along with attaching the Scope of Services as outlined in your application.

Reminder - there is a 10 MB file size maximum (approx 500 pages). If you are trying to upload a file that is larger than 10 MB, please split the document into two files, name them appropriately, and upload both files into the appropriate row.

IMPORTANT NOTE: The Zoom Grants System will allow you to submit your application without attaching the REQUIRED documents; however, if documents are missing or incomplete after the application closing date, the City will deem your application "INCOMPLETE" and IT WILL NOT BE CONSIDERED FOR FUNDING.

REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used.

REQUIRED FOR CDBG ONLY - LEVERAGING REPORT - this is due with the 2nd quarter report, no later than January 15th.
download template

Report 5due 8/31/2013 (submitted 8/29/2013)

1. Name and Title of Person Completing Report:
Irina Milinevskaya, Contracts Manager

2. Program Title:
Tri-Valley Haven's Homeless Services Program

3. Telephone:
(925) 449-5845

4. E-Mail:
irina@trivalleyhaven.org

5. Please indicate if this report is for a Community Support Grant, Community Development Block Grant or Housing In-Lieu Grant. (if same agency received funding from multiple funding sources, you must submit a separate report for each funding source).

Community Support Grant - If you checked here, please continue to answer questions 6 through 11 and 21-26 only. After that, you are through: you do not have to enter anything in the remaining question boxes.

1 total to date

Community Development Block Grant (CDBG) - if you checked here, you must answer ALL questions.

Housing In-Lieu Grant - If you checked here, please continue to answer questions 6-22 for quarterly reports. For final report, you must answer all questions.

6. How has the PROJECT/PROGRAM addressed an unmet community need & improved the qualify of life for Dublin residents?
Tri-Valley Haven Food Pantry provided any household in need with free food (ACCFB programs, in addition to donated food), personal hygiene items, household items, clothing vouchers, emergency transportation and housing, and referral resources to local social service programs and agencies. Sojourner House provided shelter, case management, life skills classes, and counseling with the goal to assist residents in ending their homelessness.

7. How many TOTAL participants were served by this PROJECT/PROGRAM THIS QUARTER? How many of those participants are Dublin residents?

Total Program Participants

5,594 total to date

Total Dublin residents

272 total to date

TOTAL

8. Please evaluate the success of your PROJECT/PROGRAM. Were the goals outlined in the application met? Was the PROJECT/PROGRAM carried out efficiently? Please use the objectives identified in your application to discuss the sucess and impact.
Even though we did not meet the goal of serving 300 Dublin residents, yes, this agency believes the food pantry program and Sojourner House are a success. Success is defined by our ability to meet, and hopefully exceed, the needs of our program participants from the Tri-Valley community.The Haven Pantry provided free food and personal necessities to low income, homeless, and “at risk of becoming homeless” Tri-Valley residents. Clothing vouchers, referrals to other social services and emergency assistance with housing and transportation was also provided. Sojourner House defines success in successfully assisting homeless families to be rehoused but there are smaller successes as well. Success can be obtaining childcare, employment, staying clean and sober, stabilizing mental illness, or stabilizing your family.

9. Were any Dublin grant funds expended for this project during this reporting period?

Yes (already submitted invoice/s)

1 total to date

Yes (but invoice/s not yet submitted)

No (no expenditures this period)

Other:

10. Please indicate how client data are reported for this project (please keep consistent for questions 11 through 13 and with your original application):

Persons

1 total to date

Households

11. Please complete the following table regarding the NUMBER OF UNDUPLICATED CLIENTS SERVED during this reporting period using the indicator chosen above (persons OR households):

A) Numeric GOAL stated in your Agreement for the number of Dublin clients to be served THIS FISCAL YEAR (unduplicated)

300 total to date

B) Number of NEW DUBLIN CLIENTS served by this project during this reporting period (unduplicated) [NOTES: In the 1st quarter report, all unduplicated clients are considered to be new. In the subsequent 3 quarterly reports, include only new unduplicated clients who were not included in the previous report.]

272 total to date

C) Number of NEW CLIENTS AGENCY-WIDE served by this project during this reporting period (unduplicated; if project serves only Dublin clients, enter a zero)

5,594 total to date

TOTAL

12. Please indicate the number of new, unduplicated DUBLIN clients served during this reporting period, as reported in 11B above, who met the following special categories (note that some clients may meet multiple categories and some not any):

Low Income (50% to 80% Median)

Very Low Income (30% to 50% Median)

Extremely Low Income (<30% Median)

Seniors (62 and older)

Disabled

Female-Headed Households

TOTAL

13. List the number of new, unduplicated Dublin clients your agency served during this reporting period in the following race/ethnicity categories. [Notes: Total must equal 11B. HUD considers "Hispanic" as an ethnicity and not a separate race.]

White

White + HISPANIC

Black/African American

Black/African American + HISPANIC

Asian

Asian + HISPANIC

American Indian/Alaskan Native

American Indian/Alaskan Native + HISPANIC

Native Hawaiian/Other Pacific Islander

Native Hawaiian/Other Pacific Islander + HISPANIC

American Indian/ Alaskan Native and White

American Indian/ Alaskan Native and White + HISPANIC

Asian and White

Asian and White + HISPANIC

Black/African American and White

Black/African American and White + HISPANIC

American Indian/Alaskan Native and Black/African American

American Indian/Alaskan Native and Black/African American + HISPANIC

Other/Multi Racial

Other/Multi Racial + HISPANIC

TOTAL

14. Please define the primary UNIT OF SERVICE you use when tracking this project, submitting invoices, etc. (e.g., hours of counseling, medical visits, meals served, miles driven, etc.; should match the unit of service stated in your Agreement/Contract.-no answer-

15. Please complete the following table regarding the UNIT OF SERVICE listed above:

Number of persons assisted with new access to a service.

Number of persons assisted with improved access to a service.

Number of persons assisted who no longer have access to a substandard service.

TOTAL

16. If you had TWO unit of service types, please define the second UNIT OF SERVICE here (if you did not have a second unit of service, enter “N/A”):-no answer-

17. Please complete the following table regarding the second UNIT OF SERVICE listed above:

Number of persons assisted with new access to a service.

Number of persons assisted with improved access to a service.

Number of persons assisted who no longer have access to a substandard service.

TOTAL

18. If you had THREE unit of service types, please define the third UNIT OF SERVICE here (if you did not have a third unit of service, enter “N/A”):-no answer-

19. Please complete the following table regarding the third UNIT OF SERVICE listed above:

Number of persons assisted with new access to a service.

Number of persons assisted with improved access to a service.

Number of persons assisted who no longer have access to a substandard service.

TOTAL

20. Please include any additional comments or clarifications here:-no answer-

21. FOR THE FINAL REPORT ONLY: Describe the original purpose for which the funds were granted. If applicable, explain why your agency did not spend the entire grant.
Tri-Valley Haven's Homeless Services Program will provide assistance with issues related to Homelessness through the Shelter, job readiness/job search Life Skills education and the Food Pantry.

22. FOR THE FINAL REPORT ONLY: Describe the accomplishments of the program funded. Provide detail on how the program responded to needs within the community. Describe any new and creative methods the agency implemented to meet community needs.
The Haven Pantry provided free food and personal necessities to low income, homeless, and “at risk of becoming homeless” Tri-Valley residents. Clothing vouchers, referrals to other social services and emergency assistance with housing and transportation was also provided.New clientele, on-going clientele and returning clientele who had been self-sustaining but unfortunately found themselves requiring help again, continue to receive our services.We collaborate with the ACCFB to provide monthly Food Stamp Outreach and the Valley Humane Society to provide free pet food once a month.We also partnered with CareMore to provide Outreach for seniors in the community looking for health services.We actively network and outreach to the local community to solicit donations to meet the needs of our program participants.This year we provided 4 clothing vouchers and 42 referrals to other social services to Dublin residents.Sojourner House continues to stabilize homeless families and assists them in ending their homelessness. It is the only program in the area that takes two-parent households, single dads, and puts no restrictions on ages of the children. Reaching the goal of ending homelessness is obtained through case management, life skills trainings, counseling, and a partnership between the resident and the staff. Residents learn how to utilize the services in the community.

23. FOR THE FINAL REPORT ONLY: Does the agency feel this program was a success? How do you measure the success of the program? Did it meet or exceed the goals and outcomes described in the performance measures in the original application? If not, why?
Even though we did not meet the goal of serving 300 Dublin residents, yes, this agency believes the food pantry program is a success. Success is defined by our ability to meet, and hopefully exceed, the needs of our program participants from the Tri-Valley community. Success for the Food Pantry is being able to provide food and social service assistance to all who are in need. No-one who is lacking food and is in need is turned away. Other measurable success criteria include the number referrals to other services and clothing vouchers provided. Sojourner house is a success as well. Success is defined as graduating into housing but it is also gaged in other ways. Success can be obtaining childcare, employment, staying clean and sober, stabilizing mental illness, or stabilizing the family.

24. FOR THE FINAL REPORT ONLY: Describe any problems/delays encountered with the project. How were they handled? What effects were there on project costs? Describe any changes that made the project successful or will make it successful in future years
No problems/delays encountered.

The Food Pantry Coordinator continues to network in the community and do Outreach to senior and low –income residents, specifically new housing developments recently opened in Dublin.

Sojourner house is also proceeded as planned sheltering homeless families in the Tri-Valley Area.

25. FOR THE FINAL REPORT ONLY: List agencies you collaborated with on this project. Describe the nature of the collaboration.
The Tri-Valley Haven Food Pantry receives a monthly food delivery from the Alameda County Food Bank consisting of USDA and Emergency Food Boxes. The Food Pantry is a member of the Tri-Valley Hunger Coalition with other Livermore food pantries and Open Heart Kitchen. This allows pantries to share resources and work together to meet the growing need.A consortium of local churches funds the ESTA (Emergency Short Term Assistance) Program, administered by the Food Pantry Coordinator, which allows the Haven to provide emergency motel, transportation and food assistance for at-risk-for-homelessness clients. The Haven Food Pantry benefits from food drives sponsored by local churches, businesses and schools. Volunteers pick up food donated from local stores. Private donors provide gift cards which allow the Haven to purchase items in low supply or items to meet special dietary requirements.We continue to collaborate with the ACCFB to provide monthly Food Stamp Outreach and the Valley Humane Society to provide free pet supplies once a month. We also partnered with CareMore to provide Outreach for seniors in the community looking for health services.

Sojourner house works closely with Twin-Valley Learning Center to provide on-site tutoring services for the children. We also work closely with Lynnewood Church, who provide graduation baskets for families moving into housing.

26. FOR THE FINAL REPORT ONLY: Did you obtain other funding sources for this particular project? If so, list sources and amounts.
N/A

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